Characteristics and outcome of surgically treated acromegaly patients attending an endocrinology clinic at a tertiary referral centre in Durban, South Africa over a period of 10 years

Background: The mode of presentation, clinical, radiologic and laboratory characteristics of patients with acromegaly and the outcome following various modalities of treatment are not well documented in South Africa.Aim: To evaluate treatment outcome and follow-up of patients with acromegaly over a period of 10 years.Methods: The study is a retrospective record review of patients with acromegaly attending Inkosi Albert Luthuli Central Hospital, Durban, 2003–2013.Results: The study included 27 patients (16 female and 11 male) with a mean age at diagnosis of 44.2 ± 14.0 years. The mean growth hormone (GH) at diagnosis was 51.8 ± 32.6 μg/l and mean IGF-1 956.8 ± 432.9 μg/l. In 25 patients (92.5%) pituitary macroadenoma was identified; microadenoma was present in 2 (7.4%) patients. Trans-sphenoidal surgery was employed in 26 (96.3%) as the initial therapy; only 1 patient was treated medically. Adjunctive medical therapy was used in 23 (88.5%) and radiotherapy in 6 (22.2%). After a mean follow-up of 4.4 ± 3.4 years, 9 (33.3%) subjects were cured (normal age-matched and gender-matched IGF-1 and random GH < 1.0 μg/l). No deaths were recorded and post-procedural hypopituitarism developed in 22 (84.6%) patients.Conclusions: Patients with acromegaly in KwaZulu-Natal present with advanced clinical features and large pituitary adenomata. The overall cure rate is lower than reported from developed countries.Keywords: acromegaly, diagnostic criteria, medical and radiotherapy, modes of treatment (surgery

Rickets mimicker: A report of two cases of primary hyperparathyroidism in adolescence

The presentation of primary hyperparathyroidism (PHPT) in most Western countries has evolved from the classic description of ‘stones, bones, and groans’ to becoming increasingly asymptomatic as a result of more frequent serum calcium screening. However, many developing countries are still reporting predominantly symptomatic PHPT with the classic complications of skeletal disease and nephrolithiasis still being quite common. Furthermore, the exact prevalence of PHPT in children is not known but it is thought to be uncommon and the clinical presentation and outcomes in this subgroup of patients are not well described in the literature. Two cases of PHPT occurring in adolescent boys are reported. Both cases initially presented with chronic bone pain involving the lower limbs and had a long delay before the diagnosis of PHPT was confirmed. They developed progressive deformities of the lower limbs, which resembled rickets clinically. Radiological features were also suggestive of rickets. However, biochemistry confirmed parathyroid hormone mediated hypercalcaemia in both cases and after parathyroid surgery a parathyroid adenoma was confirmed histologically as the aetiology of hypercalcaemia. Therefore, PHPT occurring in adolescence may have a clinical presentation almost identical to that of rickets. All patients presenting with skeletal deformities including a rickets phenotype must have serum calcium and phosphate levels measured as part of the diagnostic workup

Meta-analysis suggests differing indirect effects of viral, bacterial, and fungal plant pathogens on the natural enemies of insect herbivores

Indirect effects are ubiquitous in nature, and have received much attention in terrestrial plant–insect herbivore–enemy systems. In such tritrophic systems, changes in plant quality can have consequential effects on the behavior and abundance of insect predators and parasitoids. Plant quality as perceived by insect herbivores may vary for a range of reasons, including because of infection by plant pathogens. However, plant diseases vary in their origin (viral, bacterial or fungal) and as a result may have differing effects on plant physiology. To investigate if the main groups of plant pathogens differ in their indirect effects on higher trophic levels, we performed a meta-analysis using 216 measured responses from 29 primary studies. There was no overall effect of plant pathogens on natural enemy traits as differences between pathogen types masked their effects. Infection by fungal plant pathogens showed indirect negative effects on the performance and preference of natural enemies via both chewing and piercing-sucking insect herbivore feeding guilds. Infection by bacterial plant pathogens had a positive effect on the natural enemies (parasitoids) of chewing herbivores. Infection by viral plant pathogens showed no clear effect, although parasitoid preference may be positively affected by their presence. It is important to note that given the limited volume of studies to date on such systems, this work should be considered exploratory. Plant pathogens are very common in nature, and tritrophic systems provide an elegant means to examine the consequences of indirect interactions in ecology. We suggest that further studies examining how plant pathogens affect higher trophic levels would be of considerable value

Optimization of Lateral Jets for Guiding Supersonic Missiles

This project seeks to improve the guidance of supersonic missiles with lateral jets. This is achieved by quantifying and optimizing the pressure distributions created along the surface of the missile by the jets in different configurations. The jets themselves must be considered as well as turbulent and compressible effects and thermal losses. To explore these effects, flat plate geometry experiments of high-speed jet in cross-flow are considered for validation purpose. Group members are using FLUENT to reproduce experimental results of a jet in crossflow attempting to achieve higher accuracy by use of various solution methods. Two and three dimensional models of air vehicles equipped with jet control created using Creo and corresponding flow simulations generated in Ansys FLUENT

Characteristics and outcome of patients with pheochromocytoma at a tertiary endocrinology clinic in Durban, South Africa over 14 years

Objectives: To evaluate the characteristics and outcomes of treatment of patients with pheochromocytoma at Inkosi Albert Luthuli Central Hospital (ILACH) in Durban, South Africa over 14 years.Design: Retrospective chart review.Setting and subjects: Patients with pheochromocytoma attending the endocrinology clinic at IALCH between 2012 and 2016 were studied.Outcome measures: Clinical, biochemical and radiological data were collected at presentation, on discharge, one year and five years after surgical intervention; tumour characteristics, histopathological features and surgical outcome were also assessed.Results: The analysis included 35 patients (mean age 33.2 ± 15.7 years; 60% female). Headache (68.6%), palpitation (60%) and sweating (57.6%) were the three most common presenting symptoms; hypertension was the predominant clinical finding (85.7%). Most pheochromocytomas were sporadic (82.9%), adrenal gland tumours (68.6%) and benign (77.1%); of eight patients with malignant tumours, two were familial. Adrenalectomy was undertaken in the majority (n = 34; 97.1%); 55.2% were large tumours. The use of adjunctive radiotherapy (n = 4; 11.4%) and chemotherapy (n = 1; 2.9%) was low. There was low overall mortality (5.7%), but 57.6% developed intraoperative hypotension. At one year postoperatively, 80% (n = 28) of patients were defined as cure, biochemically in 23 (82.1%) and with radiology in five (17.9%).Conclusions: Most patients presenting to IALCH had large intra-abdominal tumours with high cure rate, low mortality but a high rate of perioperative complications. Late presentation and large tumour size was a feature.Keywords: pheochromocytoma , South Africa, surgical outcom

The effect of short-term kaempferol exposure on reactive oxygen levels and integrity of human (HL-60) leukaemic cells

AbstractFlavonoids may be a principal contributor to the cancer preventative activity of fruit- and vegetable-rich diets and there is interest in their use as dietary supplements. However, there is potential conflict between the cytoprotective and cytotoxic activities of flavonoids, and their efficacy as anti-cancer agents is unresolved. Here, the integrity and survival of HL-60 promyelocytic leukaemia cells following short-term (90 min) exposure to the dietary abundant flavonoid kaempferol (1–100 μM) is reported. Supplementation initially decreased reactive oxygen levels but, paradoxically, a dose-dependent increase in single-strand DNA breakage occurred. However, there was no increase in oxidised DNA purines or membrane damage. Following a 24-h recovery period in non-kaempferol supplemented media, DNA single-strand breakage had declined and kaempferol exposed and control cultures possessed similar reactive oxygen levels. A reduction in 3H-thymidine incorporation occurred with ≥10 μM kaempferol. One hundred micromolar kaempefrol increased the proportion of cells in G2-M phase, the proportion of cells with a sub-G1 DNA content and enhanced ‘active’ caspase-3 expression but only induced a loss of mitochondrial membrane potential within a minority of cells. The relevance of induced DNA damage within a non-overtly oxidatively stressed environment to the disease preventative and therapeutic use of kaempferol is discussed

Decarbonising the Swedish road transport sector

Road transport contributes to around one-fifth of the EU’s total CO2 emissions and is the only major sector in the EU where greenhouse gas emissions are still rising. Swedish road transport causes 30% of all emissions. Addressing transport emissions is therefore crucial for meeting the Paris Agreement commitments on climate change. The Swedish government aims to have a fossil-independent vehicle fleet by 2050; moreover, an emissions reduction target for the road transport sector of 80% (compared to 2010) by 2030 has been suggested. The government-initiated investigation ‘Fossilfrihet på väg’ sets out potential pathways, but a knowledge gap currently remains in regard to which path would be the most beneficial or least burdensome in terms of macroeconomic effects while still decarbonising the road transport sector. This paper contributes to fill that knowledge gap by applying a vehicle stock modelling framework and a demand-driven global econometric model (E3ME) and by evaluating different technology pathways for Sweden to meet the 2030 and 2050 government targets. The stock model has been adjusted to be consistent with ‘Fossilfrihet på väg’ and uses technology deployment and cost estimates to model the Swedish vehicle stock emissions in three technology-driven scenarios. The analysis shows that decarbonisation of transport can have positive impacts upon the Swedish economy, primarily through the replacement of imported fossil fuels with domestically produced electricity and biomass, while a further stimulus is provided by the construction of infrastructure to support electric vehicle recharging and fuel cell refuelling. Through quick action to encourage the deployment of new technologies and powertrains into the vehicle stock, plus policies aimed at promoting the domestic production of sustainable biomass, Sweden can maximise the potential gains from the decarbonisation process

The impacts of the trade liberalization of environmental goods on power system and CO2 emissions

The trade liberalization of Environmental Goods (EG), through as Environmental Goods Agreement (EGA), is crucial in low carbon electricity technology diffusion. However, there is a big gap of the EG definition lists and the integrated effectiveness analysis of EGA. This paper analyses the effects of the trade liberalization of EG based on macroeconomic and electricity sector models and attempts to find a more efficient EG trade policy by comparing different EG lists, considering end-use control and combining the EG policy with a carbon tax. The results show that the trade liberalization of EG does not necessarily benefit the environment without other policies, as the effects of the multiple end-uses of EG on conventional energy might result in environmental damage. We find that merging an EGA into a global carbon tax system would enhance the effects of carbon tax on CO2 reduction by 33%, and simultaneously lower the GDP loss due to the carbon tax by 75%. The economic benefits from the EGA could offset the costs of other environmental policies. Thus, end-use control and other environmental policies should be considered at both the global and regional levels in the setting of international trade agreements that target EG

The South African Philatelist : 1962

The Philatelic Federation of South Africa (PFSA) is a voluntary association organised as a federation of clubs & societies for stamp collectors and philatelists of all ages and all types. To produce the up-to-date journal locally is no easy matter, but we shall continue to give our readers what we think they will appreciate most. The journal is managed by a collector for the benefit of collectors, and as no dealer has any choice in the management, philatelists will realise that they have a paper which will cater for their wants, and give them reliable, unbiassed advice.The South African Philatelist, January - December (1962)Digitised by the Department of Library Services in support of Open Access to information, University of Pretoria.pm202